Looking Beyond Health-Related Quality of Life: Predictors of Subjective Well-Being among People Living with HIV in the Netherlands

Patient experiences with value-based healthcare interventions at the HIV outpatient clinic of the Erasmus Medical Centre

BACKGROUND

One of the aims of value-based healthcare (VBHC) is to deliver more patient-centred care. However, little is known about the effect of VBHC interventions on patient experiences. We aim to explore how patients experience VBHC as implemented in an HIV outpatient clinic in an academic hospital in the Netherlands.

METHODS

The HIV outpatient clinic of the Erasmus MC, Rotterdam, the Netherlands, an academic tertiary hospital, implemented a VBHC intervention consisting of 1) implementation of a generic quality of life questionnaire, administered before each visit, 2) a change in consultation schedule; from twice a year face-to-face to one face-to-face double consultation and one remote consultation per year, and 3) a change in consultation structure; from a single face-to-face consultation with the infectious diseases (ID) specialist to a double consultation in which the patient visits both the nurse and the ID specialist. Semi-structured interviews were held with Dutch or English-speaking adult patients, that had been a patient within Erasmus MC for more than 5 years, on their experiences with the implemented changes.

RESULTS

Thirty patients were interviewed. Patients had no objections towards completing the questionnaires especially if it could provide the professionals with additional information. Patients were primarily positive about the change in consultation schedule. For the yearly remote consultation they preferred a telephone-consultation above a video-consultation. The change in consultation structure ensured that more topics, including psychosocial and medical aspects could be discussed. Some patients did not see the added value of talking to two professionals on the same day or completing the quality of life questionnaire before their consultation.

CONCLUSION

Patients are generally positive towards the VBHC interventions implemented at the HIV outpatient clinic. Our findings may inform further optimization of VBHC interventions and improve patient-centred care in outpatient HIV clinics.

Profiles of subjective well-being among people living with HIV during the COVID-19 pandemic

BACKGROUND

The aim of our study was to examine subjective well-being (SWB) profiles and their sociodemographic and clinical correlates among people living with HIV (PLWH) during the COVID-19 pandemic.

METHODS

The participants were 663 PLWH undergoing antiretroviral treatment. Their SWB was evaluated using the Satisfaction with Life Scale and the Positive and Negative Affect Schedule. Sociodemographic and clinical covariates, together with COVID-19 distress, were assessed with a self-report survey.

RESULTS

Latent profile analysis revealed four SWB profiles: average negative, average positive, flourishing and languishing. The languishing profile was the worse in terms of values of SWB components and had a relative overrepresentation of PLWH who were single, without a university degree, and not employed for money. The pandemic-related distress was positively related to being a member of average negative and languishing profiles. Gender and age had no significant effect on either profile membership or directly on the SWB components.

CONCLUSION

It seems that in the context of chronic illness and socially shared stressful circumstances, which was the COVID-19 pandemic, the components of SWB among PLWH developed rather congruent profiles. Sociodemographic, but not clinical characteristics were found to be significant correlates of belonging to obtained SWB profiles in this sample. The most striking effect with this regards was obtained for the members of the languishing profile, defined by the co-occurrence of low positive affect, low satisfaction with life, and high negative affect.

Relationship between health-related quality of life and subjective wellbeing in asthma

OBJECTIVE

Poor health-related quality of life (HRQoL) is associated with a high risk of acute exacerbations in patients with asthma. The use of health state utility instruments to measure HRQoL is common, but it has been criticised for failing to adequately capture the impact of the condition from the patient perspective. We aimed to assess the ability of subjective wellbeing and health state utility instruments to capture important HRQoL dimensions for asthma patients.

METHODS

Regression analyses were conducted using data (n = 856 asthma patients) from a large multi-national cross-sectional survey to explore the relationship between subjective wellbeing (ONS4, PWI, SWLS), health state utility (15D, AQoL-8D, EQ-5D-5L, HUI3, SF-6D, SF-6Dv2), and an asthma-specific instrument (AQLQ-S). The latent structure of different instruments was investigated using an exploratory factor analysis.

RESULTS

All instruments could distinguish the impact of asthma on HRQoL. Among health utility instruments, 15D, SF-6D and AQoL-8D were more sensitive based on the average standardised regression coefficients. AQOL-8D had the strongest correlation with subjective wellbeing. Nevertheless, the exploratory factor analysis showed a complementary relationship between subjective wellbeing and HRQoL instruments. The most important subjective wellbeing domains were standard of living, achieving in life, and personal relationships; although contributions of these domains to overall life satisfaction differed among asthma patients identified by a latent class analysis.

CONCLUSION

The use of subjective wellbeing alongside AQLQ-S and health state utility instruments provides a comprehensive approach to assess the impact of asthma on the patient's life. Further research is needed to incorporate these measures in health care evaluation.

Personality types and subjective well-being among people living with HIV: a latent profile analysis

PURPOSE

We examined whether three types of personality (i.e. resilient, undercontrolled and overcontrolled) based on the Big Five personality taxonomy could be replicated among people living with HIV (PLWH). We also aimed to establish significant sociodemographic and clinical covariates of profile membership and verify whether these profiles are related to the subjective well-being (SWB) of participants.

METHODS

770 PLWH participated in this study. The Big Five personality traits were evaluated with the NEO-FFI questionnaire. SWB was operationalised by satisfaction with life (Satisfaction with Life Scale) and positive and negative affects (PANAS-X). Moreover, sociodemographic and clinical variables were collected.

RESULTS

Latent profile analysis was used to identify personality types among participants. Instead of the three profiles most frequently reported in the literature, we identified a four-profile model (the resilient, undercontrolled, overcontrolled and the average profile type) as the best fit to the data. These profiles did not differ with regard to sociodemographic and clinical covariates. However, significant differences in SWB across profiles were noted, i.e. the highest SWB was observed among members of the resilient profile, and overcontrollers and undercontrollers were almost equally regarded as second best in SWB level, whereas the average profile consists of PLWH with the worst SWB.

CONCLUSION

Identifying personality types in clinical settings enables more comprehensive understanding of interrelations between personality and health. Regarding PLWH, the typological approach may shed new light on ambiguous results devoted to the role of personality in well-being of these patients.

Trajectories of Health-Related Quality of Life and Perceived Social Support Among People Living With HIV Undergoing Antiretroviral Treatment: Does Gender Matter?

The study examined the trajectories of health-related quality of life (HRQoL) and perceived social support (PSS) among people living with HIV (PLWH), with a special focus on gender differences. The participants included 252 PLWH (18% female) undergoing antiretroviral therapy. HRQoL (WHO Quality of Life-BREF; WHOQOL Group, 1998) and PSS (Berlin Social Support Scales; Schulz and Schwarzer, 2003) were measured three times at six-month intervals. Using a univariate approach, three trajectories of HRQoL and four trajectories of PSS were identified. Gender and relationship status were significant covariates for PSS only, with overrepresentation of single women in the increasing trajectory. The dual trajectory approach revealed a match in the decrease of HRQoL and PSS, but only for 31% of the sample. In fact, decreasing PSS co-occurred with increasing as well as stable HRQoL. There was no significant gender effect in this regard. Although a clear correspondence for decreasing trajectories exists, the findings also highlight a discrepancy between HRQoL and PSS changes that are unrelated to gender.

Characterizing the disability experience among adults living with HIV: a structural equation model using the HIV disability questionnaire (HDQ) within the HIV, health and rehabilitation survey

BACKGROUND

People aging with HIV can experience a variety of health challenges associated with HIV and multimorbidity, referred to as 'disability'. Our aim was to characterize the disability experience and examine relationships between dimensions of disability among adults living with HIV.

METHODS

We performed a structural equation modeling analysis with data from the Canadian web-based HIV, Health and Rehabilitation Survey. We measured disability using the HIV Disability Questionnaire (HDQ), a patient-reported outcome (69 items) that measures presence, severity and episodic features of disability across six domains: 1) physical symptoms, 2) cognitive symptoms, 3) mental-emotional health symptoms, 4) difficulties carrying out day-to-day activities, 5) uncertainty and worrying about the future, and 6) challenges to social inclusion. We used HDQ severity domain scores to represent disability dimensions and developed a structural model to assess relationships between disability dimensions using path analysis. We determined overall model fit with a Root Mean Square Error of Approximation (RMSEA) of < 0.05. We classified path coefficients of ≥ 0.2-0.5 as a medium (moderate) effect and > 0.5 a large (strong) effect. We used Mplus software for the analysis.

RESULTS

Of the 941 respondents, most (79%) were men, taking combination antiretroviral medications (90%) and living with two or more simultaneous health conditions (72%). Highest HDQ presence and severity scores were in the uncertainty domain. The measurement model had good overall fit (RMSEA= 0.04). Results from the structural model identified physical symptoms as a strong direct predictor of having difficulties carrying out day-to-day activities (standardized path coefficient: 0.54; p < 0.001) and moderate predictor of having mental-emotional health symptoms (0.24; p < 0.001) and uncertainty (0.36; p < 0.001). Uncertainty was a strong direct predictor of having mental-emotional health symptoms (0.53; p < 0.001) and moderate direct predictor of having challenges to social inclusion (0.38; p < 0.001). The relationship from physical and cognitive symptoms to challenges to social inclusion was mediated by uncertainty, mental-emotional health symptoms, and difficulties carrying out day-to-day activities (total indirect effect from physical: 0.22; from cognitive: 0.18; p < 0.001).

CONCLUSIONS

Uncertainty is a principal dimension of disability experienced by adults with HIV. Findings provide a foundation for clinicians and researchers to conceptualize disability and identifying areas to target interventions.

Religious Fundamentalism, Satisfaction with Life and Posttraumatic Stress Symptoms Intensity in a Polish Sample of People Living with HIV/AIDS

We investigated the relationship between religious fundamentalism, satisfaction with life and the intensity of posttraumatic stress symptoms in people living with HIV/AIDS. The study was conducted on 283 adults, including 242 HIV-positive patients and 41 individuals with AIDS, aged from 20 to 74. Religious fundamentalism was positively correlated with age and posttraumatic stress symptoms intensity. Negative correlation between satisfaction with life and posttraumatic stress intensity was also found. Religious fundamentalism and satisfaction with life accounted for 34% of the variance in posttraumatic stress symptoms intensity. The level of patients' education mediated the relationship between religious fundamentalism and the posttraumatic stress symptoms intensity.

Revisiting Successful Aging With HIV Through a Revised Biopsychosocial Model: An Update of the Literature

The concept of successful aging was recognized only recently by HIV researchers because people living with HIV (PLWH) in the early epidemic were not expected to survive. With the introduction of antiretrovirals that block viral replication, PLWH are now aging with HIV. Given the complex nature of HIV within the social, economic, and political climates in which it occurs, a holistic model of successful aging is needed to guide researchers and clinicians. Several overarching models exist, but must be updated for rapidly advancing HIV and aging research agendas. We provide an updated, adapted, and integrated biopsychosocial model of successful aging with HIV based on the principles of Baltes and Baltes (1998) on 8 essential components of successful aging: (a) length of life, (b) biological health, (c) mental health, (d) cognitive efficiency, (e) social competence, (f) productivity, (g) personal control, and (h) life satisfaction. Clinical practice and research implications are highlighted.

Beyond viral suppression: the quality of life of people living with HIV in Sweden

Sweden has one of the best HIV treatment outcomes in the world and an estimated 95% of all diagnosed people living with HIV are virally suppressed, but the quality of life (QoL) is understudied. The aim of this study was to examine the associations between variables within sociodemographic, behavioural, clinical, psychological, sexual life, social support and personal resource component and the QoL of people living with HIV in Sweden. Data were derived from a cross-sectional, nation-wide survey completed by 15% (n = 1096) of all people living with HIV and collected at 15 infectious disease clinics and 2 needle exchange sites during 2014. Ordinal univariate and multivariate logistic regression analyses were used to examine associations between potential contributors and QoL. Respondents reported high QoL: 63% rated their QoL 7 or higher on a scale ranging from 0 to 10. QoL was independent of gender, age, mode of HIV transmission and country of origin. Lower QoL was associated with recent homelessness, hazardous alcohol consumption, comorbidities, treatment side-effects, HIV-related physical symptoms, hopelessness, negative self-image, sexual dissatisfaction, and negative changes in sex life after HIV. The QoL of people living with HIV in Sweden was high overall, but still significantly influenced by HIV.

Consistency of health-related quality of life among people living with HIV: Latent statetrait analysis

Background

The aim of this longitudinal study was to examine the consistency of health-related quality of life (HRQoL) among people living with HIV (PLWH) by breaking down the variance of repeated HRQoL measures into trait, state, and method components and to test the stability of HRQoL over time. In addition, we wanted to examine whether HRQoL trait components are related to personality traits, while controlling for selected socio-medical variables.

Methods

Three assessments were performed with a six-month lag on each assessment. Each participant filled out a World Health Organization (WHO) Quality of Life-BREF to assess HRQoL and a NEO-FFI to measure Big Five personality traits. Overall, 82 participants out of 141 (58.2% of the initial sample) participated in all the assessments.

Results

The HRQoL among PLWH represented a stable trait to a somewhat greater extent than a situational variability, although the proportions were domain and time variant. More specifically, psychological domain appeared to be the most consistent, whereas social domain appeared to be the most prone to situational influences. The trait component of HRQoL was positively related to being in a relationship, being employed, and being extraverted, and negatively related to neuroticism, which altogether explained 26% of the trait variance.

Conclusions

HRQoL among PLWH is rather distinct from personality and socio-medical data, which indicates its uniqueness in a clinical practise. Thus, there is a need for a more comprehensive assessment of HRQoL among this patient group to capture an additional source of variance in this important theoretical construct.

Development and validation of PozQoL: a scale to assess quality of life of PLHIV

Background

Advances in medical treatment for HIV are driving major changes in HIV policy and practice, including the encouragement of intake and adherence to HIV antiretroviral treatment (ART) by people living with HIV (PLHIV) for both personal and public health benefits. However, there is increasing recognition that achieving these goals will require a concurrent focus on the broader psychological and social wellbeing of PLHIV. Increasingly calls are being been made to incorporate a stronger focus on quality of life (QoL) of PLHIV into HIV prevention policy.

In order to achieve this goal, HIV community, support and healthcare services need a valid, short and practical way to evaluate QoL of PLHIV accessing their programs. Current QoL measures are either long, complex, restricted in their use, or expensive. To address these shortcomings, the PozQoL study aimed to develop, test and validate a short and freely available scale assessing QoL among PLHIV.

Methods

Drawing on a literature review, the prioritisation of domains and development of the initial pool of items was conducted in consultation with PLHIV community organisations in Australia. The items covered health concerns, psychological, social, and functional wellbeing. Testing involved a baseline and a follow-up survey of 465 adult Australians living with HIV. Participants were recruited through social media and various community organizations nationwide. The survey included the pilot PozQoL scale and other validated measures of health and wellbeing.

Results

Guided by an Exploratory Factor Analysis and conceptual considerations, a 13-item scale was developed. The PozQoL scale demonstrated high levels of fit in a Confirmatory Factor Analysis, very good internal consistency, test-retest reliability, and concurrent validity with other measures that approximated different aspects of QoL.

Conclusion

The PozQoL scale has been tested in a diverse sample of adult PLHIV living in Australia, demonstrating very good reliability and validity. The insights from PLHIV and other stakeholders supported the balancing of statistical rigour and conceptual accuracy. The scale is now ready to be implemented and field-tested across a range of community, support and healthcare programs for PLHIV. This will make a significant contribution to the evaluation and enhancement of programs for PLHIV.

HIV symptom management self-efficacy mediates the relationship of internalized stigma and quality of life among people living with HIV in China

HIV-related stigma negatively influences quality of life among people living with HIV. Little is known about psychological protective factors that mitigate negative impacts. This study aims to examine the role of self-efficacy in reducing effects of stigma on quality of life. A total of 2987 people living with HIV (age: M = 42.46 years, SD = 12.83; time since diagnosis: M = 3.23 years, SD = 2.39) provided data on internalized stigma, HIV symptom management self-efficacy, and health-related quality of life, as well as covariates. Using structural equation modeling, we found that self-efficacy mediated the relationship of stigma and quality of life. Future interventions to promote quality of life in people living with HIV need to focus on increasing HIV symptom management self-efficacy.

The role of basic psychological need satisfaction, sleep, and mindfulness in the health-related quality of life of people living with HIV

Research has not yet examined the relationship between psychological need satisfaction, sleep, mindfulness, and health-related quality of life in people living with HIV. This cross-sectional study ( N = 101; 84% male; mean age = 45.48, SD = 12.75) found need satisfaction to relate positively to physical and mental health. Sleep quality fully mediated the association with physical health and partially mediated the association with mental health. Furthermore, mindfulness related to higher sleep quality through higher need satisfaction. Findings underscore the role of need satisfaction in determining health-related quality of life and sleep quality in people living with HIV and suggest that mindfulness may facilitate need satisfaction.

Affectivity as mediator of the relation between optimism and quality of life in men who have sex with men with HIV

Background/Objective: Increased life expectancy has made quality of life the primary objective in the care of chronic patients and people living with HIV. It found evidence of the link between optimism, quality of life and well-being. This article aimed to determine whether affectivity in its two dimensions (positive and negative) played a mediating role in the association between optimism and quality of life in men living with HIV. Method: 116 men living with HIV (the average age was 36.8 years (SD=9.06), and the average time from the diagnosis was 8.2 years) responded to three instruments: Life Orientation Test revised version (LOT-R), the Positive and Negative Affect Schedule (PANAS) and the World Health Organization Quality of Life-Bref (WHOQoL-Bref). Results: The results showed that positive affect had no mediating effect, whereas negative affect mediated the relation of optimism with two quality-of-life dimensions (overall quality of life and environment). Conclusion: In conclusion, negative affect was found to participate only partially, acting as a mediating variable.

Field Psychometric Testing of the Instrument for Assessment of Psychological Predictors of Well-Being and Quality of Life in People with HIV or AIDS

The Screenphiv, a screening measure for psychological issues related to HIV, was psychometrically tested in a study involving 744 HIV-infected people in Spain. Participants ages 18-82 (M = 43.04, 72 % men, 28 % women) completed an assessment protocol that included the Screenphiv and the MOS-HIV. A trained interviewer also collected relevant illness-related clinical data and socio-demographics from the participants. A confirmatory factor analysis was used to evaluate the goodness of fit of the Screenphiv's theoretical model and confirmed six first-order factors and two second-order factors [RMSEA (IC 90 %) = 0.07 (0.07-0.08)]. No floor or ceiling effects were observed for the scores. Cronbach's alphas were acceptable for all of the factors (from 0.65 to 0.92). Criterion-related validity also achieved; Screenphiv scores were related to socio-demographic and clinical variables and MOS-HIV summary scores. The Screenphiv is a reliable and valid measure, ready to use in research and clinical settings in Spain.